WOODLANDS HOME FOR THE AGED (Outbreak of cholera)

Mr J.B. Jeyaretnam asked the Minister for Social Affairs if he will make a statement on the recent outbreak of cholera in the Woodlands Home for the Aged.

Mr S. Chandra Das asked the Minister for Social Affairs (a) what were the causes for the outbreak of cholera and subsequent deaths in the Woodlands Home for the Aged; (b) whether he is satisfied with the hygienic conditions of all the "Homes" in Singapore; and (c) what measures are being taken to prevent recurrence of similar situations.

The Minister for Social Affairs (Dr Ahmad Mattar): Mr Speaker, Sir, since Questions 3 and 4 are related, may I be permitted to answer them together?

Mr Speaker: Yes.

Dr Ahmad Mattar: Thank you, Sir. Mr Speaker, Sir, the recent outbreak of cholera in the Woodlands Home for the Aged was caused by the introduction of cholera bacteria into the Home from an outside source. A resident helper in the kitchen was infected through consuming contaminated food brought to him by a relative. He developed diarrhoea on 14 August and was diagnosed to be suffering from cholera on 18 August. Up to 7 September, a total of 21 residents were infected with cholera and 76 were identified as carriers.

Four of the cholera victims died. The causes of death were 'acute myocardial infarction' and 'acute cerebral infarction' in an 85-year old resident, 'cardio-respiratory failure' in an 82-year old resident, 'acute intestinal gangrene' in a 75-year old resident and 'acute gastroenteritis' in a 90-year old resident. It can be seen that two of the four victims died because of their frailty and low resistance to the cholera bacteria.

Mr Speaker, Sir, certain newspapers have given wide publicity to the outbreak and attributed the spreading of the disease within the Home mainly to the unsanitary condition of the toilets. While a few toilets serving the male residents were defective at the time of the outbreak and some others were not quite clean, these were in themselves not the main cause for the spread of the disease in the Home. The frailty of most of the residents in the Home, many of whom are incontinent and have poor control over their bowels, were a more significant factor. It was unfortunate that an infected resident helper in the kitchen was not detected as a cholera victim and isolated until after several days. He was the initial source of the spread of the cholera.

My staff have done what they could within the available manpower resources of the Woodlands Home for the Aged. Mr Speaker, Sir, the relevant issue to consider here is whether we can afford to deploy a staff force to ensure at all times personal hygiene and complete cleanliness of the toilets and premises of these Homes. Although the State has a duty to care for the residents in these Welfare Homes, I am of the view that we must do the best with the resources available. Measures taken to prevent recurrence of similar situations

The Member for Chong Boon has asked what measures have been taken to prevent recurrence of similar situations. Mr Speaker, Sir, this incident in the Woodlands Home was an unfortunate one. The Home has been in existence for 20 years and there has hitherto been no epidemic or even food poisoning.

Nonetheless, we have taken several immediate measures to prevent recurrence of a similar outbreak. Only freshly cooked food is allowed into the Homes. All residents and food handlers are made to wash their hands before touching food and drinks. All food handlers will be screened regularly by the Ministry of Health. A new working procedure for minor repairs has been introduced which allows the Superintendent of the Home to get the work done by any nearby contractor if the term contractor appointed by PWD fails to respond to a request for minor repairs within a reasonable time. The existing PVC toilet cisterns will be phased out and replaced by heavy duty ones.

Hygienic Conditions of the Homes

The Ministry of Social Affairs runs three Homes for the aged and destitutes and nine Homes for children and young persons. I am satisfied with the hygienic conditions of these Homes. Frequent inspections we conducted by my staff and by members of the Boards of Visitors appointed by the Director of Social Welfare.

For the long term, my Ministry has instituted a thorough review of all its institutions. The review may result in the relocation of some Homes to more appropriate localities with purpose-built facilities.

Mr S. Chandra Das (Chong Boon): Sir, I would like to ask the Minister why the toilets were in an unsatisfactory condition in the first place.

Dr Ahmad Mattar: Mr Speaker, Sir, the problem of dirty and choked toilets is not. peculiar to Woodlands Home for the Aged only. It happens almost everywhere. Maybe I should draw the attention of the Member to an article which appeared in one of the September issues of Sunday Times. I cannot remember the date. In fact, this article was written by an employee of the Straits Times. She bemoans the fact that we Singaporeans have not been educated in our toilet habits. According to her, even young, healthy office workers dirty the toilets no matter how new the environment of the office and the toilets may be.

Even in the Straits Times, according to her, although the toilets are about two years old, the handles to the water closets are already breaking and repairs to choked toilets have been less than prompt. Only a couple of days ago we read in The Monitor that the sanitation in the toilets of NUS has improved after the Member for Whampoa brought it up at an exhibition last week.

Sir, the problem with the Woodlands Home for the Aged is that, as I mentioned in my answer earlier on, most of the 600-plus residents are old, incontinent and have poor control over their bowels. But we will do our best with whatever resources available.

Mr Jeyaretnam: Mr Speaker, Sir, would the Minister answer the question that was asked of him by the last Member, and that is, how long have the lavatories been not functioning properly in this Woodlands Home for the Aged before the cholera outbreak was detected?

Secondly, has the Home adequate staff to cope adequately with bedridden patients, people who are unable to take care of themselves in their bowel movements or their habits, or are they just left to look after themselves?

Dr Ahmad Mattar: To answer the first question, repairs were done almost immediately after it happened.

Mr Jeyaretnam: How long were they malfunctioning?

Dr Ahmad Mattar: As I replied to the Member for Chong Boon, because of the fact that the residents are old, frail and incontinent, dirty and choked toilets occur frequently and we attend to them as soon as we can.

To his second question, with the present staff to resident ratio of 1:12, 1 think we can manage with the problem. We have been managing this for the last 20 years. We will continue to manage. We will do our best with the resources available.

Mr Jeyaretnam: Would the Minister appoint a committee to inquire into the conditions at the Woodlands Home for the Aged before the outbreak of cholera and the causes that led to this outbreak?

Dr Ahmad Mattar: The answer is no. I have my Boards of Visitors appointed by the Director of Social Welfare and they consist of members of the public. They visit the Homes regularly, not only the Woodlands Home for the Aged but all the other Homes under the Ministry. There is no need for any committee of inquiry.

Mr Jeyaretnam: Would the Minister say whether he has made any inquiry, whether through his Boards of Visitors or through his officials, and if he has, will he make public the report of this committee or Board that inquired into it?

Dr Ahmad Mattar: I have inquired into the events that led to the cholera outbreak, and the answer today is a report of that report.